Publications
323 results found
Biddiscombe MF, Usmani OS, 2021, Delivery and adherence with inhaled therapy in asthma, MINERVA MEDICA, Vol: 112, Pages: 564-572, ISSN: 0026-4806
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- Citations: 5
Baldi S, Usmani O, Warren S, et al., 2021, Lung deposition and distribution of inhaled extra fine beclomethasone dipropionate / formoterol fumarate /glycopyrronium bromide (BDP/FF/GB) in subjects with and without airflow obstruction, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Kocks J, Wouters H, Bosnic-Anticevich S, et al., 2021, Late Breaking Abstract - Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Garner JL, Biddiscombe MF, Meah S, et al., 2021, Endobronchial valve lung volume reduction and small airways function, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Biddiscombe M, Matthews J, Wright M, et al., 2021, NO EVIDENCE THAT ELECTROSTATIC CHARGE NEAR HIGH VOLTAGE POWER LINES INCREASES THE DEPOSITION OF INHALED ULTRAFINE ENVIRONMENTAL PARTICLES IN HUMAN LUNGS, Publisher: MARY ANN LIEBERT, INC, Pages: A3-A4, ISSN: 1941-2711
van Boven JFM, Dierick BJH, Usmani OS, 2021, When biology meets behaviour: can medication adherence mask the contribution of pharmacogenetic effects in asthma?, EUROPEAN RESPIRATORY JOURNAL, Vol: 58, ISSN: 0903-1936
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- Citations: 4
Usmani OS, Dhand R, Lavorini F, et al., 2021, Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease, MAYO CLINIC PROCEEDINGS, Vol: 96, Pages: 2448-2463, ISSN: 0025-6196
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- Citations: 14
Kocks JWH, Andringa HJH, van Heijst E, et al., 2021, Aeroallergen sensitization for detecting asthma in primary care: A diagnostic test accuracy study, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1080-1084, ISSN: 0954-7894
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- Citations: 3
Usmani OS, Hickey AJ, Guranlioglu D, et al., 2021, The impact of inhaler device regimen in patients with asthma or COPD, Journal of Allergy and Clinical Immunology: In Practice, Vol: 9, Pages: 3033-3040.e1, ISSN: 2213-2198
Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. A targeted literature search was performed and additional articles were identified through hand searching citations within screened publications. A total of 114 articles were included in the final review. Findings suggest that simplifying inhaler regimens by applying the same type of inhaler for concomitant inhaled medications over time minimizes device misuse, leading to improved clinical outcomes and reduced health care use in patients with asthma or COPD. Physicians should consider a patient's suitability for a device and training needs when prescribing an inhaled medication and before changing the medication type or dose, especially when suboptimal treatment outcomes are observed. Further research is required to determine whether consistent use of the same device type is associated with better treatment adherence and persistence in patients with asthma or COPD. Nevertheless, this literature review identified clinical benefits and reduced health care use with simplified inhaler regimens.
Spencer S, Hamer O, Berger E, et al., 2021, Interventions to improve inhaler technique for adults with chronic obstructive pulmonary disease, Cochrane Database of Systematic Reviews, Vol: 2021, ISSN: 1465-1858
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To evaluate the impact of interventions to improve inhaler technique on performance and clinical outcomes in people with COPD.
Usmani OS, Han MK, Kaminsky DA, et al., 2021, Seven Pillars of Small Airways Disease in Asthma and COPD Supporting Opportunities for Novel Therapies, CHEST, Vol: 160, Pages: 114-134, ISSN: 0012-3692
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- Citations: 18
Usmani OS, Mignot B, Kendall I, et al., 2021, Predicting lung deposition of extrafine inhaled corticosteroid-containing fixed combinations in patients with chronic obstructive pulmonary disease using functional respiratory imaging: AnIn SilicoStudy, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 3, Pages: 204-211, ISSN: 0894-2684
Background: Functional respiratory imaging (FRI) is a computational fluid dynamics-based technique using three-dimensional models of human lungs and formulation profiles to simulate aerosol deposition.Methods: FRI was used to evaluate lung deposition of extrafine beclomethasone dipropionate (BDP)/formoterol fumarate (FF)/glycopyrronium bromide (GB) and extrafine BDP/FF delivered through pressurized metered dose inhalers and to compare results with reference gamma scintigraphy data. FRI combined high-resolution computed tomography scans of 20 patients with moderate-to-severe chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second 42% predicted) with in silico computational flow simulations, and incorporated drug delivery parameters to calculate aerosol airway deposition. Inhalation was simulated using profiles obtained from real-life measurements.Results: Total lung deposition (proportion deposited in intrathoracic region) was similarly high for both products, with mean ± standard deviation (SD) values of 31.0% ± 5.7% and 28.1% ± 5.2% (relative to nominal dose) for BDP/FF/GB and BDP/FF, respectively. Pairwise comparison of the deposition of BDP and FF gave a mean intrathoracic BDP/FF/GB:BDP/FF deposition ratio of 1.10 (p = 0.0405). Mean intrathoracic, central and peripheral deposition ratios for BDP were 1.09 (95% confidence interval [CI]: 1.05–1.14), 0.92 (95% CI: 0.89–0.96), and 1.20 (95% CI: 1.15–1.26), respectively, and for FF were 1.11 (95% CI: 1.07–1.15), 0.94 (95% CI: 0.91–0.98), and 1.21 (95% CI: 1.15–1.27), within the bioequivalence range (0.80–1.25) for intrathoracic and central regions, and slightly exceeding the upper boundary in the peripheral region. Mean ± SD central:peripheral deposition (C:P) was 0.48 ± 0.13 for BDP/FF/GB and 0.62 ± 0.17 for BDP/F
Scullion J, Usmani O, 2021, Advances in inhaler technology: influences on choice, Practice Nurse, Vol: 51, Pages: 28-32, ISSN: 0953-6612
Bousquet J, Jutel M, Akdis CA, et al., 2021, ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020), Allergy, Vol: 76, Pages: 689-697, ISSN: 0105-4538
Garner J, Biddiscombe MF, Meah S, et al., 2021, Endobronchial valve lung volume reduction and small airways function., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 1576-1579, ISSN: 1073-449X
Almeshari M, Alobaidi NY, Sapey E, et al., 2021, SMALL AIRWAYS RESPONSE TO BRONCHODILATOR IN ASTHMA AND COPD: A SYSTEMATIC REVIEW, Publisher: BMJ PUBLISHING GROUP, Pages: A129-A129, ISSN: 0040-6376
Haughney J, Lee AJ, McKnight E, et al., 2021, Peak inspiratory flow measured at different inhaler resistances in patients with asthma, Journal of Allergy and Clinical Immunology: In Practice, Vol: 9, Pages: 890-896, ISSN: 2213-2198
BACKGROUND: Patients' peak inspiratory flow rate (PIFR) may help clinicians select an inhaler device. OBJECTIVE: To determine the proportion of patients with asthma who could generate correct PIFRs at different inhaler resistance settings. METHODS: During a UK asthma review service, patients' PIFR was checked at resistance settings matching their current preventer inhaler device, at R5 (high resistance dry powder inhaler (DPI)) and at R0 (low resistance, pressurised metered dose inhaler (pMDI)). Correct PIFR ('pass') was defined for R5 as 30-90 L/min and for R0 as 20-60 L/min. A logistic regression model examined the independent predictors of incorrect PIFR ('fail') at R5 and R0. Asthma severity was assessed retrospectively from treatment level. RESULTS: A total of 994 adults (female 64.3%) were included, of whom 90.4% currently used a preventer inhaler (71.5% pMDI). PIFR pass rates were: 93.7% at R5 compared with 70.5% at R0 (p<0.0001). All patients failing the R0 PIFR breathed in too fast (>60 L/min), and 20% of patients currently using pMDI failed for this reason. Independent risk factors for failing R5 were: female gender, older age group and current preventer pMDI; and for failing R0 included: male gender, younger age group, current preventer DPI and mild versus severe asthma. CONCLUSIONS: This study demonstrates that most patients with asthma can achieve adequate inspiratory flow to activate high resistance DPIs, whereas approximately a third of patients breathe in too fast to achieve recommended inspiratory flows for correct pMDI use, including one fifth of patients who currently use a pMDI preventer.
Dreher M, Price D, Gardev A, et al., 2021, Patient perceptions of the re-usable Respimatt(R) Soft Mist (TM) inhaler in current users and those switching to the device: A real-world, non-interventional COPD study, Chronic Respiratory Disease, Vol: 18, Pages: 1-10, ISSN: 1479-9723
The Respimat® Soft Mist™ inhaler (SMI) has recently been improved, with a re-usable device replacing the disposable version. Certain countries are currently phasing out the disposable inhaler. This study aimed to assess patient satisfaction with and preference for the re-usable device. This 4–6-week, multicentre, open-label, prospective, real-world, non-interventional study was conducted across six European countries. Patients with chronic obstructive pulmonary disease were enrolled between October and December 2019, in three cohorts: (1) currently using the re-usable Respimat SMI; (2) switched from disposable Respimat SMI at study entry; and (3) naïve to any Respimat SMI. Patients were assessed using the Patient Satisfaction and Preference Questionnaire (PASAPQ) and Ease of Handling Questionnaire. In total, 262 patients were enrolled. At follow-up, the mean PASAPQ score was 83.3/100 overall, with similar results across all three patient cohorts. Most patients were ‘satisfied’ or ‘very satisfied’ with the re-usable device. The overall score for willingness to continue using the device was 87.8/100. In total, 13 adverse events were recorded, none of which was classified as serious. This study provides real-world evidence for practitioners to start patients on Respimat re-usable, irrespective of a patient’s prior experience with this inhaler.
Pleasants RA, Tilley SL, Hickey AJ, et al., 2021, User-life of ICS/LABA inhaler devices should be considered when prescribed as relievers, EUROPEAN RESPIRATORY JOURNAL, Vol: 57, ISSN: 0903-1936
Usmani OS, 2021, Inhaler Devices, Encyclopedia of Respiratory Medicine, Second Edition, Pages: 754-765, ISBN: 9780081027233
Inhalation is the cornerstone in the management of airway disease. By targeting drug directly to the lungs, inhalation compared to systemic therapy has key advantages that translate into therapeutic benefit for patients. There are four main classes of inhaler device used in everyday clinical practice available with a variety of drugs for the treatment of patients with asthma and COPD. Global directives now emphasize the assessment of inhaler technique, adherence and adjustment of the inhaler device as part of their core management cycles. Healthcare professionals therefore must have clear knowledge of inhaler devices and be proficient in their use, in order to select the right device for the right patient. Errors in the inhaler technique by the patient lead to significantly poor disease outcomes and significantly greater health-economic burden. Respiratory prescribing is unique in that it is the only branch of medicine where treatment efficacy depends not only the medication class but also the inhaler device. The inhaler device is as important as the pharmacological drug.
Conway J, Biddiscombe M, Usmani O, 2021, Inhaled aerosols: Emerging clinical methods, Inhaled Medicines: Optimizing Development through Integration of In Silico, In Vitro and In Vivo Approaches, Pages: 359-373, ISBN: 9780128149744
The pattern of deposition of inhaled aerosols in the lungs of man in health and disease, in vivo, is reliant on multiple factors. The disease being targeted has a major influence on the eventual site of deposition. Obstructive lung disease alters the flow dynamics within the airways and restrictive lung diseases alters the ‘stiffness’ of the lungs and ability to inhale large volumes. There are multiple methods used to assess the fate of an inhaled aerosol within the lungs and the consequent clinical effect. Imaging allows visualization of inhaled aerosols via the use of labeling with radio-isotopes combined with imaging techniques such as planar scintigraphy, single photon emission computed tomography (SPECT) and positron emission tomography (PET). Computed tomography (CT), and magnetic resonance imaging (MRI) allow visualization of the structure of the lung and can also offer information of physiological dysfunction. Data from imaging can be related to physiological measurements of lung function and to clinical outcome. The combination of lung CT images with Computational Fluid and Particle Dynamics (CFPD) simulations has led to the development of personalized functional modeling of the airways to investigate disease in the small and large airways. All of these methods have advantages, disadvantages and limitations. None of these methods are able to directly visualize the small airways which is frequently the area of interest in lung disease. There are emerging methods of interest that may offer further data on the effects of inhaled therapeutic agents including novel MRI methods and use of micro-CT to investigate changes in small airway function. This chapter will summarize developments relating to inhaled aerosols and emerging clinical methods used to assess efficacy.
Soni S, Garner J, O'Dea K, et al., 2021, Intra-alveolar neutrophil-derived microvesicles are associated with disease severity in COPD, American Journal of Physiology: Lung Cellular and Molecular Physiology, Vol: 320, Pages: L73-L83, ISSN: 1040-0605
Despite advances in the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD), there is a distinct lack of biochemical markers to aid clinical management. Microvesicles (MVs) have been implicated in the pathophysiology of inflammatory diseases including COPD but their association to COPD disease severity remains unknown. We analysed different MV populations in plasma and bronchoalveolar lavage fluid (BALF) taken from sixty-two patients with mild to very severe COPD (51% male; mean age: 65.9 years). These patients underwent comprehensive clinical evaluation (symptom scores, lung function, exercise testing) and the capacity of MVs to be clinical markers of disease severity was assessed. We successfully identified various MV subtype populations within BALF (leukocyte, PMN (polymorphonuclear leukocyte i.e. neutrophil), monocyte, epithelial and platelet MVs) and plasma (leukocyte, PMN, monocyte and endothelial MVs), and compared each MV population to disease severity. BALF neutrophil MVs were the only population to significantly correlate with the clinical evaluation scores including FEV1, mMRC dyspnoea score, 6-minute walk test, hyperinflation and gas transfer. BALF neutrophil MVs, but not neutrophil cell numbers, also strongly correlated with BODE index. We have undertaken, for the first time, a comprehensive evaluation of MV profiles within BALF/plasma of COPD patients. We demonstrate that BALF levels of neutrophil-derived MVs are unique in correlating with a number of key functional and clinically-relevant disease severity indices. Our results show the potential of BALF neutrophil MVs for a COPD biomarker that tightly links a key pathophysiological mechanism of COPD (intra-alveolar neutrophil activation) with clinical severity/outcome.
Bousquet J, Anto JM, Bachert C, et al., 2021, ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice., Allergy, Vol: 76, Pages: 168-190, ISSN: 0105-4538
Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis.It strengthens the ARIA change management strategy in the prevention and managementof airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
Almeshari MA, Alobadidi NY, Sapey E, et al., 2021, Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 16, Pages: 3065-3082, ISSN: 1178-2005
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- Citations: 4
Price D, Jones R, Pfister P, et al., 2021, Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes, PRAGMATIC AND OBSERVATIONAL RESEARCH, Vol: 12, Pages: 25-35, ISSN: 1179-7266
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- Citations: 5
Usmani OS, Roche N, Jenkins M, et al., 2021, Consistent Pulmonary Drug Delivery with Whole Lung Deposition Using the Aerosphere Inhaler: A Review of the Evidence, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 16, Pages: 113-124, ISSN: 1176-9106
Metered dose inhalers (MDIs) are one of the most common device types for delivering inhaled therapies. However, there are several technical challenges in development and drug delivery of these medications. In particular, suspension-based MDIs are susceptible to suspension heterogeneity, in vitro drug-drug interactions, and patient handling errors, which may all affect drug delivery. To overcome these challenges, new formulation approaches are required. The AerosphereTM inhaler, formulated using co-suspension delivery technology, combines drug crystals with porous phospholipid particles to create stable, homogenous suspensions that dissolve once they reach the airways. Two combination therapies using this technology have been developed for the treatment of COPD: glycopyrrolate/formoterol fumarate (GFF MDI; dual combination) and budesonide/glycopyrrolate/formoterol fumarate (BGF MDI; triple combination). Here, we review the evidence with a focus on studies assessing dose delivery, lung deposition, and effects on airway geometry. In vitro assessments have demonstrated that the Aerosphere inhaler provides consistent dose delivery, even in the presence of simulated patient handling errors. Combination therapies delivered with this technology also show a consistent fine particle fraction (FPF) and an optimal particle size distribution for delivery to the central and peripheral airways even when multiple drugs are delivered via the same inhaler. Studies using gamma scintigraphy and functional respiratory imaging have demonstrated that GFF MDI is effectively deposited in the central and peripheral airways, and provides clinically meaningful benefits on airway volume and resistance throughout the lung. Overall, studies suggest that the Aerosphere inhaler, formulated using co-suspension delivery technology, may offer advantages over traditional formulations, including consistent delivery of multiple components across patient handling conditions, optimal particle size and FPF
Alzahabi KH, Usmani O, Georgiou TK, et al., 2020, Approaches to treating tuberculosis by encapsulating metal ions and anti-mycobacterial drugs utilizing nano- and microparticle technologies, Emerging Topics in Life Sciences, Vol: 4, Pages: 581-600, ISSN: 2397-8554
Tuberculosis (TB) is caused by a bacterial infection that affects a number of human organs, primarily the lungs, but also the liver, spleen, and spine, causing key symptoms of fever, fatigue, and persistent cough, and if not treated properly, can be fatal. Every year, 10 million individuals become ill with active TB resulting with a mortality approximating 1.5 million. Current treatment guidelines recommend oral administration of a combination of first-line anti-TB drugs for at least 6 months. While efficacious under optimum conditions, ‘Directly Observed Therapy Short-course’ (DOTS) is not without problems. The long treatment time and poor pharmacokinetics, alongside drug side effects lead to poor patient compliance and has accelerated the emergence of multi-drug resistant (MDR) organisms. All this, combined with the limited number of newly discovered TB drugs to treat MDR-TB and shorten standard therapy time, has highlighted the need for new targeted drug delivery systems. In this respect, there has been recent focus on micro- and nano-particle technologies to prepare organic or/and metal particles loaded with TB drugs to enhance their efficacy by targeted delivery via the inhaled route. In this review, we provide a brief overview of the current epidemiology of TB, and risk factors for progression of latent stage tuberculosis (LTBI) to the active TB. We identify current TB treatment regimens, newly discovered TB drugs, and identify studies that have used micro- or nano-particles technologies to design a reliable inhalation drug delivery system to treat TB more effectively.
Bakakos A, Loukides S, Usmani OS, et al., 2020, Biologics in severe asthma: the overlap endotype-opportunities and challenges, EXPERT OPINION ON BIOLOGICAL THERAPY, Vol: 20, Pages: 1427-1434, ISSN: 1471-2598
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- Citations: 13
Soriano JB, Anzueto A, Anticevich SB, et al., 2020, Face masks, respiratory patients and COVID-19, European Respiratory Journal, Vol: 56, ISSN: 0903-1936
Usmani OS, Scichilone N, Mignot B, et al., 2020, Airway deposition of extrafine inhaled triple therapy in patients with COPD: A model approach based on functional respiratory imaging computer simulations, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 15, Pages: 2433-2440, ISSN: 1176-9106
Introduction: There is a clear correlation between small airways dysfunction and poor clinical outcomes in patients with chronic obstructive pulmonary disease (COPD), and it is therefore important that inhalation therapy (both bronchodilator and anti-inflammatory) can deposit in the small airways. Two single-inhaler triple therapy (SITT) combinations are currently approved for the maintenance treatment of COPD: extrafine formulation beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide (BDP/FF/GB), and non-extrafine formulation fluticasone furoate/vilanterol/umeclidinium (FluF/VI/UMEC). This study evaluated the lung deposition of the inhaled corticosteroid (ICS), long-acting β2-agonist (LABA), and long-acting muscarinic antagonist (LAMA) components of these two SITTs.Materials and Methods: Lung deposition was estimated in-silico using functional respiratory imaging, a validated technique that uses aerosol delivery performance profiles, patients’ high-resolution computed tomography (HRCT) lung scans, and patient-derived inhalation profiles to simulate aerosol lung deposition.Results: HRCT scan data from 20 patients with COPD were included in these analyses, who had post-bronchodilator forced expiratory volume in 1 second (FEV1) ranging from 19.3% to 66.0% predicted. For intrathoracic deposition (as a percentage of the emitted dose), deposition of the ICS component was higher from BDP/FF/GB than FluF/VI/UMEC; the two triple therapies had similar performance for both the LABA component and the LAMA component. Peripheral deposition of all three components was higher with BDP/FF/GB than FluF/VI/UMEC. Furthermore, the ratios of central to peripheral deposition for all three components of BDP/FF/GB were < 1, indicating greater peripheral than central deposition (0.48± 0.13, 0.48± 0.13 and 0.49± 0.13 for BDP, FF and GB, respectively; 1.96± 0.84, 0.97± 0.34 and 1.20± 0.48 for FluF, VI and UMEC, respecti
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